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Coma Exam

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421. Fulminant encephalopathy in a child with hyperferritinemic sepsis: a case report. Full Text available with Trip Pro

of a 5-year-old girl who presented with abdominal pain, vomiting, recurrent seizures, and coma. Brain magnetic resonance imaging (MRI) showed diffuse white matter abnormalities in the brain on day 1. Cerebrospinal fluid (CSF) tests revealed that protein levels and glucose levels were normal without pleocytosis. CSF PCRs for pathogens were all negative. The electroencephalography examination demonstrated diffuse, generalized and slow background activity. The patient showed the symptom

2020 BMC Neurology

422. Theoretical Analysis of Wave-Front Aberrations Induced from Conventional Laser Refractive Surgery in a Biomechanical Finite Element Model. Full Text available with Trip Pro

Theoretical Analysis of Wave-Front Aberrations Induced from Conventional Laser Refractive Surgery in a Biomechanical Finite Element Model. To examine the biomechanical effects-induced wave-front aberrations after conventional laser refractive surgery.A finite element model of the human eye was established to simulate conventional laser refractive surgery with corrected refraction from -1 to -15 diopters (D). The deformation of the anterior and posterior corneal surfaces was obtained under (...) consisted of spherical aberration, vertical coma, and y-trefoil. Spherical aberration was significantly positively correlated to enhanced refraction correction. The effect of posterior corneal surface on induced wave-front aberration was less than the anterior corneal surface. The IOP slightly affects the postoperative defocus, coma, and spherical aberration. When treatment decentration occurred during the procedure, the hyperopic shift decreased as the eccentricity increased. Treatment decentration had

2020 Investigative Ophthalmology & Visual Science

423. Relationship between volume of services and quality of treatment outcome for complex oesophagael interventions - Rapid report

National Health Service RCT Randomized controlled trial SEER Surveillance, Epidemiology and End Results Program SGB Sozialgesetzbuch (Social Code Book) VoS Volume of services Extract of rapid report V19-04 Version 1.0 Relationship between volume of services and quality for oesophageal surgery 24 April 2020 Institute for Quality and Efficiency in Health Care (IQWiG) - 1 - 1 Background Relationship between volume of services and quality of treatment outcome As early as in 1979, Luft et al. examined (...) The assessment included studies with adult patients who underwent complex oesophageal interventions. 4.1.2 Volume of services The VoS was defined as the number of performed complex oesophageal interventions per hospital, per physician, or per hospital-physician combination within a defined time period. 4.1.3 Outcomes For the investigation, the following outcomes were examined: ? Mortality, such as ? overall survival ? intraoperative or perioperative mortality ? inpatient mortality ? Morbidity

2020 Plant signaling & behavior

424. Legal and Ethical Issues related to Resuscitation

may not be given without consent if the provider knows or could be reasonably expected to know that the victim objects to the care. The care given and the reasons must be certified in the clinical records (GAA s64). Care defined as health care does not include first-aid treatment, or non-intrusive examination for diagnostic purposes (e.g. visual examination of mouth, throat, nasal cavity, eyes or ears) or administration of a pharmaceutical drug which is non-prescriptive, normally self-administered (...) that: the opinion is supported by the written opinion (if practicably obtainable) of another medical practitioner who has examined the victim; the victim has not refused consent; and the medical practitioner has enquired whether the victim (if 16 years or over) has given an advance directive. However, a medical practitioner may treat a victim despite an advance care directive if reasonably believing that the directive is not intended to apply to treatment of the kind proposed and to the circumstances

2015 Australian Resuscitation Council

425. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis. Full Text available with Trip Pro

Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis. Diabetic ketoacidosis in children may cause brain injuries ranging from mild to severe. Whether intravenous fluids contribute to these injuries has been debated for decades.We conducted a 13-center, randomized, controlled trial that examined the effects of the rate of administration and the sodium chloride content of intravenous fluids on neurologic outcomes in children with diabetic ketoacidosis. Children were randomly (...) assigned to one of four treatment groups in a 2-by-2 factorial design (0.9% or 0.45% sodium chloride content and rapid or slow rate of administration). The primary outcome was a decline in mental status (two consecutive Glasgow Coma Scale scores of <14, on a scale ranging from 3 to 15, with lower scores indicating worse mental status) during treatment for diabetic ketoacidosis. Secondary outcomes included clinically apparent brain injury during treatment for diabetic ketoacidosis, short-term memory

2018 NEJM Controlled trial quality: predicted high

426. Policy on Obstructive Sleep Apnea

and poor school performance due to misdiagnosed ADHD, aggressive behavior, or developmental delay. 1 Rare sequelae of untreated OSA include brain damage, seizures, coma, and cardiac complications. 1-3 These children also may experience impaired growth. 1,2 Etiology of OSA Patients with certain anatomic anomalies, craniofacial anom- alies, neuromuscular diseases, or Down syndrome are at increased risk for development of obstructive sleep apnea. 5 Anatomic anomalies may include hypertrophic tonsils (...) may contribute to OSA. 3 Diagnosis of OSA Pediatric dentists are in a unique position to be able to iden- tify patients at greatest risk. Adenotonsillar hypertrophy 6 and obesity are major risk factors for OSA in otherwise healthy children. With a history and careful clinical examination at each dental visit, pediatric dentists may identify signs and symptoms that may raise a concern for OSA. Assessment of tonsillar hypertrophy 6 and percentage of airway obstruction by the Friedman Tongue

2016 American Academy of Pediatric Dentistry

427. Development and validation of a prognostic model to predict death in patients with traumatic bleeding, and evaluation of the effect of tranexamic acid on mortality according to baseline risk: a secondary analysis of a randomised controlled trial

shorten the time to diagnostic and life-saving procedures such as surgery and TXA. Objectives We aimed to develop a simple prognostic model that could be used at the point of care to estimate risk of death in patients with traumatic bleeding and to examine how TXA treatment effects vary according to the baseline risk of death in bleeding trauma patients. Methods We derived prognostic models in a large placebo-controlled trial of the effects of early administration of a short course of TXA (CRASH-2 (...) for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK. HEALTH TECHNOLOGY ASSESSMENT 2013 VOL. 17 NO. 24 (EXECUTIVE SUMMARY) iii We then used the prognostic model to stratify the patients in the CRASH-2 trial who were treated within 3 hours of injury into four mortality risk strata ( 50%) and examined the effect of TXA

2013 NIHR HTA programme

428. The role of biomarkers in ruling out cerebral lesions in mild cranial trauma

261Cs ¦ FOREWORD This morning, Johanne was surprised by the first night frost. On her way to work, the front wheel of her bike slipped on the ground frost and she fell. Since she briefly lost consciousness and had a wound on her forehead, witness of the accident called for assistance and Johanne ended up in the emergency department. Despite a reassuring history and physical examination, the question on whether she could have injured her brain remained unanswered. It is at this point of the story (...) ) and the elderly (aged over 75). 1 There is a distinction between mild (or light), moderate and severe cranial trauma. Such distinction is most often based on the Glasgow Coma Scale (GCS): a 3 to 15-point scale used to assess patients’ level of consciousness and neurologic functioning after a head injury (see Table 1). Mild cranial trauma (mCT) often defined as GCS 13-15 is by far, the most frequent, accounting for as many as 71% to 98% of cases and is the subject of interest of this review. 5 Biomarkers

2016 Belgian Health Care Knowledge Centre

429. Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Position Statement on the Optimal Care of the Post Arrest Patient Full Text available with Trip Pro

[erratum in 2002;346:1756]. N Engl J Med . 2002 ; 346 : 549–556 | | | , x 18 Laurent, I., Adrie, C., Vinsonneau, C. et al. High-volume hemofiltration after out-of-hospital cardiac arrest: a randomized study. J Am Coll Cardiol . 2005 ; 46 : 432–437 | | | | | or a score on the Glasgow Coma Scale of < 8. x 19 Nielsen, N., Wetterslev, J., Cronberg, T. et al. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. N Engl J Med . 2013 ; 369 : 2197–2206 | | | We define

2016 Canadian Cardiovascular Society

430. Unusual Cancers of Childhood Treatment (PDQ®): Health Professional Version

.[ ] Preoperative evaluation.[ ] A comprehensive ultrasound of all regions of the neck using a high-resolution probe and Doppler technique should be obtained by an experienced ultrasonographer. A complete ultrasound examination should be performed before surgery. The addition of cross-sectional imaging (contrast-enhanced computed tomography [CT] or magnetic resonance imaging) should be considered when there is concern about invasion of the aerodigestive tract. Importantly, if iodinated contrast agents are used

2018 PDQ - NCI's Comprehensive Cancer Database

431. Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: a systematic review and overview of reviews

relevant papers, of which 2545 were removed at title, abstract or full-paper sift, resulting in 27 papers that met the inclusion criteria. These studies comprised 22 systematic reviews and ?ve RCTs. The systematic reviews examined the use of aspirin for primary prevention of CVD (n=9) cancer (n=6) and CVD in patients with diabetes (n=7) while the RCTs assessed the use of aspirin for primary prevention of CVD (n=3) and CVD in patients with diabetes (n=2). Quality ratings were in general high. We found (...) unpleasant side effects that occasionally may be life-threatening. This short report aims to review and examine the relevant evidence. In this report we interpret primary prevention as de?ned for CVD by the National Institute for Health and Care Excellence (NICE) as follows ‘... interventions that aim to prevent CV [cardiovascular] events in people who have no clinical evidence of CVD’. 1 A similar de?nition may be used for primary prevention of cancer; we employ a corresponding de?nition by substituting

2013 NIHR HTA programme

432. Summary of recommendations for the diagnosis and treatment of malaria by the Committee to Advise on Tropical Medicine and Travel (CATMAT)

or complicated malaria requires admission to hospital for regular monitoring of respiratory rate and pattern, coma score, and glucose and urine output, especially if the patient is unconscious. In high levels of parasitemia, exchange transfusion may be beneficial to remove infected red blood cells and toxic mediators from the circulation, and reduce the parasite load . Because of the elevated risk of severe or complicated malaria, those with a diagnosis of Plasmodium falciparum malaria should also (...) for parenteral treatment, for exchange transfusion or for admission to an intensive care unit (ICU). In addition, it is important for monitoring response to treatment. Microscopy, which involves examining thick and thin blood smears, is both rapid and accurate. A Canadian laboratory should be able to confirm the presence of a parasite and, in most cases, identify the species within one to two hours of receiving a blood specimen . However, accurate examination of a blood smear requires considerable training

2014 CPG Infobase

433. Recovery: care of the child/young person

Recovery: care of the child/young person Recovery: care of the child/young person | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Recovery: care of the child/young person Recovery: care of the child/young person ) ( ). Preoperative assessment for general anaesthesia The anaesthetist will assess the child in order to ascertain if s/he is fit enough to undergo anaesthesia and surgery. This is likely to include an examination of the respiratory (...) and depolarising muscle relaxants such as suxamethonium. Rationale 62: If treated promptly most patients recover although there remains a mortality rate of around 5% ( ). Rationale 63: To determine the patient’s conscious level. Rationale 64: Those with a conscious level of less than 8 (as per Great Ormond Street Hospital’s (GOSH) coma scale) will be comatose and have an unprotected airway. Rationale 65: To detect potential complications of neurosurgery such as raised intracranial pressure and the presence

2015 Publication 1593

434. Assessing Fitness to Drive

Roles and responsibilities of health professionals 17 4. Licensing and medical fitness to drive 20 4.1 Medical standards for private and commercial vehicle drivers 20 4.2 Considerations for commercial vehicle licensing 20 4.3 Prescribed periodic medical examinations for particular licensing/authorisation classes 22 4.4 Conditional licences 22 4.5 Reinstatement of licences or removal or variation of licence conditions 25 5. Assessment and reporting process – step by step 26 5.1 Which forms to use 29 (...) of their patients, having regard to their medical fitness • conduct medical examinations for the licensing of drivers as required by state and territory driver licensing authorities • provide information to inform decisions on conditional licences, and • recognise the extent and limits of their professional and legal obligations with respect to reporting fitness to drive. The publication also aims to provide guidance to driver licensing authorities in making licensing decisions. With these aims in mind

2016 Cardiac Society of Australia and New Zealand

436. Early Enteral Combined with Parenteral Nutrition Treatment for Severe Traumatic Brain Injury: Effects on Immune Function, Nutritional Status and Outcomes(△). (Abstract)

in Neurological Intensive Care Unit (NICU). Patients of STBI who met the enrolment criteria (Glasgow Coma Scale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were admi- nistrated EN, PN or EN+PN treatments respectively. The indexes of nutritional status, immune function, complications and clinical outcomes were examined and compared statistically. Results There were 120 patients enrolled in the study, with 40 pationts in each group. In EN+PN group, T lymthocyte subsets CD3

2017 Chinese medical sciences journal = Chung-kuo i hsueh k'o hsueh tsa chih Controlled trial quality: uncertain

437. Thermal resilience may shape population abundance of two sympatric congeneric Cotesia species (Hymenoptera: Braconidae). Full Text available with Trip Pro

congeneric parasitoid species Cotesia sesamiae Cameron and Cotesia flavipes Cameron (Hymenoptera: Braconidae), we examined basal thermal tolerance to understand potential impact of climate variability on their survival and limits to activity. We measured upper- and lower -lethal temperatures (ULTs and LLTs), critical thermal limits [CTLs] (CTmin and CTmax), supercooling points (SCPs), chill-coma recovery time (CCRT) and heat knock-down time (HKDT) of adults. Results showed LLTs ranging -5 to 5°C and -15 (...) to -1°C whilst ULTs ranged 35 to 42°C and 37 to 44°C for C. sesamiae and C. flavipes respectively. Cotesia flavipes had significantly higher heat tolerance (measured as CTmax), as well as cold tolerance (measured as CTmin) relative to C. sesamiae (P<0.0001). While SCPs did not vary significantly (P>0.05), C. flavipes recovered significantly faster following chill-coma and had higher HKDT compared to C. sesamiae. The results suggest marked differential basal thermal tolerance responses between

2018 PLoS ONE

438. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients Full Text available with Trip Pro

, American College of Chest Physicians/La Société de Réanimation de Langue Française Statement on Competence in Critical Care Ultrasonography divides echocardiography skills into two competency levels: basic and advanced ( ). BCU is performed as a goal-directed examination using transthoracic echocardiography (TTE) or TEE 2D imaging to identify specific findings and to answer focused clinical questions. ICU providers may readily achieve competence in basic BCU. Competence in advanced BCU allows (...) , that the unprecedented expansion of bedside ultrasonography as a bedside tool will increase the number of clinicians utilizing this technology who might benefit from these guidelines . These guidelines are not intended to endorse a specific type of BCU—complete or focused—nor the use of specific ultrasound systems—portable versus full sized. Instead, these guidelines attempt to provide the rationale for intensivists with different levels of expertise and training to perform bedside examination or to seek expert

2016 Society of Critical Care Medicine

439. Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient

meetings and communicated via e-mail to examine the evidence and develop these practice guidelines. Annually, all members completed conflict of interest statements; no conflicts were identified. This activity was funded by the Society for Critical Care Medicine, and no industry support was provided. Methods: Using the Grading of Recommendations Assessment, Development, and Evaluation system, the Grading of Recommendations Assessment, Development, and Evaluation expert on the Task Force created profiles (...) (in-service exam committee). Dr. Patterson disclosed family relationships with makers of healthcare products (he is an employee of the University of Nebraska Medical Center) and disclosed non-governmental research grant funding (Co-PI for a Surviving Sepsis in Resource Limited Environment Grant from European Society of Intensive Care Medicine and Hellman Foundation). Dr. Sands disclosed family relationships with makers of healthcare products, for-profit of healthcare services/products, and with providers

2016 Society of Critical Care Medicine

440. Management of Concussion-mild Traumatic Brain Injury (mTBI)

criteria obtained during a history and physical exam (see Algorithms for definition). Symptoms associated with mTBI are identified while conducting the history of present illness. The signs and symptoms associated with mTBI are evaluated through physical examination and history and are treated in accordance with this guideline. This recommendation was not reviewed in the recent literature review; however, the strength of this recommendation is strong. The content of the 2009 mTBI CPG was reviewed (...) category of severity, the higher severity level is assigned) Criteria Mild Moderate Severe Structural imaging Normal Normal or abnormal Normal or abnormal Loss of Consciousness (LOC) 0-30 min >30 min and 24 hours Alteration of consciousness/ mental state (AOC)* up to 24 hours >24 hours; severity based on other criteria Posttraumatic amnesia (PTA) 0-1 day >1 and 7 days Glasgow Coma Scale (GCS) (best available score in first 24 hours)** 13-15 9-12 12 weeks post-injury B. Additional Educational Materials

2016 VA/DoD Clinical Practice Guidelines

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